Once You Go Laser, You Won’t Need a Razor

 

Last week, as I was thinking about what to write for this week’s newsletter,  I realized that I have not yet written about laser hair removal, which is actually my most common procedure.  So far, my hair removal patients are predominately female, and frequently have unwanted strands expunged from areas including the face, underarms, forearms and legs.  However, more males are coming in for removal of back and chest hair.

 

Laser hair removal is a medical procedure that uses laser light to eliminate unwanted hair.  Of course, waxing and plucking have the same purpose, but the effects are far more painful and often times not permanent.  Instead of just removing strands of hair from the skin’s surface, the laser light passes through the skin and targets the pigment melanin in the hair root.  When the laser beam hits the root, provided the hair is in its active growth phase, the intense heat produced by the laser destroys it.  Once the root is destroyed, the hair is killed permanently and never grows back.  Think of it this way: once you go laser, you won’t need a razor.

 

Since only 10 to 15% of hairs in a particular area of the body are actively growing on any given day, multiple laser treatments are needed to remove unwanted hair indefinitely.  Hair color and skin type are important factors in the speed of success of laser hair removal.  This treatment is most successful in the darkest hair, and is a much more prolonged process in grey, blonde or red hair.

 

Laser hair removal is also most effective when the hairs are growing and visible.  Therefore, it’s okay to shave the unwanted strands prior to treatment, but waxing or plucking them are not recommended.  In fact, for many patients who pluck hair daily, they are frequently amazed by much hair they need treated when they stop plucking.  From now on, you all can consider waxing and plucking a thing of the past; so 20^th Century, if you will. 

 

When the laser light produces the heat at the root, the patient feels a snapping sensation, like a rubber band hitting their skin.  This sensation is most intense in body areas where the hairs are most concentrated (such as the chin) and where the nerve endings are most plentiful (such as the upper lip).  There is a brief moment of pain, but it is very quick and goes away as fast as it came. In fact, it is probably more painful to wait for that feeling than it is to actually receive it.  Don’t worry, though.  Just remember that the long term advantages of the procedure far exceed the short term consequences.

 

I recommend that all hair removal patients be pretreated with an anesthetic cream for 30-60 minutes prior to the operation.  As with all laser procedures, the patient wears special protective goggles.  Immediately before the excision, I place a cold gel on the hair removal target area to cool the skin because the laser does generate a lot of heat.  The tip of the laser probe is also cooled by a cold solution circulating through the tip.  When the procedure is complete, I place a cold compress over the treated area to reduce the redness of the skin produced by the laser heat.  This redness is temporary and is generally gone in the next several hours at most.

 

Over the next several days following the procedure, some patients will notice hairs actually falling out, especially in areas where the hairs are most dark and coarse.  Over the next several weeks and especially as multiple procedures are done, there will be noticeable reduction in hair growth in a particular zone.

 

Amazingly, despite the drumbeat of negative business news about the economy, record numbers of people are requesting Botox treatments from Maine Laser Skin Care this year, definitely outpacing our previous record pace from last year.  Although I have written extensively about Botox in prior newsletters and blog entries,  several questions come up recently and frequently enough to warrant further attention here.

 

“How do you (Dr. Burke) decide how much Botox to use?”

 

As many of you may know, Botox is measured in units as opposed to milligrams which most other medications are measured in.  The amount of Botox units that I recommend depends on the area of the face involved, whether the person has had Botox in that area before, and finally how strong the muscles are in that area.  In general, facial muscles in younger people are stronger.  The muscles are also stronger if Botox has not been used in that area before.

 

The glabellar area (between the eyebrows and just above the nose) possesses the strongest muscles of the upper face and therefore requires the most Botox, especially for the initial treatment.  I generally start with 20 units spread in 3-5 injections, although some younger and first treatment patients may require up to 30 units in that area.

 

The forehead area wrinkles are formed by a much weaker and thinner muscle called the frontalis.  In this area, I start with 12 units in 4-6 injections and I generally don’t have to go above 15 units.

 

The “crow’s feet” areas around the eyes are formed by the orbicularis oculi muscle, which is also a weaker muscle compared to the glabellar area.  It is also a circular muscle and very shallow below the skin close to the eye. I use 12-15 units in 6 injections divided between the two sides.

 

My philosophy is that in this area of medicine, there is a lot of art involved.  Before the operations, I always have people smile, scowl and squint to show me how their muscles function to form their individual wrinkles or lines and how strong these muscles are.  This gives me a good idea of how much Botox to start off with, especially in this initial evaluation and treatment.

 

“How do you decide where to inject the Botox?”

 

When I was initially trained in the use of Botox a number of years ago, I reviewed the anatomy of the facial muscles and learned about the recommended sites of injection.  Since the upper face is the most common site for Botox injection, it is important not to inject Botox too close to the eyes.  In those initial courses, precise measurements are made and marks are made on the face to designate the sites of injection.

 

As anyone can tell by looking at different people’s faces, everybody’s face is slightly different. Some people have high or narrow foreheads; some have high cheekbones or narrow eyes.  As a doctor, I have to analyze each individual person’s face and decide the best sites for Botox injection.  Just as a surgeon does not mark the abdomen when he/she performs an appendectomy or a hair stylist does not have to measure the length of hair that he/she cuts, I no longer mark the person’s face.  Having injected Botox for over 5 years and having treated over 200 people with Botox in 2008 alone, writing on a person’s face is thankfully no longer necessary for me.

 

I have found that for each individual person’s face, my adjustment of injection sites and the dosage of Botox creates the best results.  By using this method, my patient satisfaction is very high and most patients want repeat treatments when their previous Botox wears off.

I hope that the information above answers some of your questions.  If you have any other questions concerning this article and any other skin issues, please leave a comment on this blog or call our office directly at (207) 873-2158 or email through our website.

Starting off, I would like to thank Marion Kenyon and the staff of Apollo Day Spa for inviting me to participate in their Open House on February 13.  I performed a number of demonstrations using Botox and Juvederm tissue filler and answered many great questions from the observers present.  In fact, their questions inspired me to fill this week’s newsletter with some basic but pertinent information about fillers and their most recent advancements.

 

The first soft tissue fillers consisted of bovine collagen, a substance first approved by the FDA back in 1981.  As the name bovine would suggest, this product came from collagen collected from cows after they were slaughtered.  The bovine was then ground up, purified, sterilized, and ultimately injected into people’s skin for correcting scars and filling lines & wrinkles.  Even if the concept of being injected by cow material does not sound bad enough to you in a Frankenstein-like way, there were in fact many other disadvantages.  The results did not last long, and patients needed prior skin testing as allergic reactions at injection sites were common.

 

Fortunately, there have been tremendous advances in filler biotechnology since the days of injecting cow parts into human skin.  Although no perfect filler exists, hyaluronic acid fillers remain the most reliable on the market.  Most of the fillers produced by various companies are based on this chemical.  Hyaluronic acid (HA) is a naturally occurring chemical that is highly concentrated in connective tissue and collagen.  It is ideal to use because it is chemically the same as human tissue, thereby eliminating the need for skin testing and having virtually no adverse reactions.  I have been using these materials in my practice for five years, and none of my patients have ever had a negative skin reaction.

 

One of the most important features of HA is that it is hydrophilic, meaning that it attracts and binds water.  As a result of this characteristic, it can intertwine with the body’s own collagen, giving the skin area flexibility while also hydrating the area, thereby adding smoothness and substance to the skin.  With aging and damage to the skin (think sun and smoking), naturally formed HA decreases.  This reduction of HA causes dehydration of the skin and loss of flexibility, finally resulting in wrinkles.

 

If pure, natural HA is injected under the skin, like collagen, it can be rapidly broken down by the body and removed.  The companies that make the current generation of HA fillers form a more stable molecule by a chemical process called “cross-linking”.  This “cross-linking” makes the chemical resistant to breaking down while retaining its ability to attract water.  The most cross-linked versions of HA are essentially thicker or more concentrated, making them last longer. That is why Perlane and Juvederm UltraPlus, the thickest products currently approved by the FDA, are rated to last at least one full year.

 

I always truthfully tell my patients who are receiving fillers (and observers) that the lines and wrinkles will look better immediately after the procedure and will improve steadily over the next several weeks.  I have even seen cases where the improvement is noticeable over a period of several hours, demonstrating the fullness progressively over that time.

 

The whole area of dermal fillers is an exciting field where research is ongoing constantly and I have continued to follow new developments through the medical literature and regular conferences.  I will inform you all as new products come on the market, along with information on which products actually work and which you should not waste your money on.

 

If you have any questions concerning this post and any other skin issues, please leave a comment, or call our office directly at (207) 873-2158 oremail through our website.

LATISSE: A BREAKTHROUGH PRODUCT FOR EYELASHES

 

Allergan, the company that develops Botox and Juvederm, rolled out a new product named “Latisse” just last year.  Approved by the FDA, Latisse is the first prescription treatment for eyelash hypotrichosis.  That’s a complicated word, I know, but it’s otherwise known as “not enough” or “inadequate eyelashes”.

 

The chemical component of Latisse, bimatoprost ophthalmic solution, was originally developed to be put in the eye as an eyedrop to treat glaucoma, and it is still also used for that purpose.  Interestingly enough, patients who were using the drops for glaucoma noticed an unexpected side effect: their eyelashes would grow longer, darker and thicker than before the treatment.  As a result of this observation, further testing and research was done, ultimately resulting in the development of Latisse.

 

Latisse affects the growth, or anagen phase, of the eyelash hair cycle by increasing both the length of the phase and the number of hairs.  When Latisse is applied to the upper eyelid once every day, effects like hair growth come gradually.  In clinical trials, Latisse users saw significant improvement in 8 weeks.  At week 16, statistics show 25% increase in eyelash length, 106% increase in eyelash thickness and 18% increase in eyelash darkness.

 

Latisse is safe when used as directed, but there are some restrictions.  Latisse should not be used if the person is allergic to eye drops or has been diagnosed with eye pressure problems such as glaucoma.  The most common side effects are eye itching or redness reported in about 4% of users.Using Latisse is relatively easy.  First, any eye makeup and contact lenses must be removed, preferably before bedtime.  Second, one drop of Latisse is placed on an applicator which comes included with the prescription. This applicator is then drawn across the upper eyelid margin at the base of the eyelashes.

 

Since Latisse is an FDA-approved prescription medication, you will need to consult a doctor (like me) to discuss the risks versus benefits.  Most pharmacies will not actually be carrying such a specialized product.  No need to worry, though.  At Maine Laser Skin Care, we will be dispensing the medication, and Latisse will not be covered by insurance prescription plans.

 

At this point, we are taking names of patients who are interested in Latisse and will be scheduling consultations when it is officially available, which will be soon.  We will also be having more information concerning Latisse on our website shortly.  Give Becky Gilbert a call at (207) 873-2158 to get on the Latisse consult waiting list.  Meanwhile, if you have any other questions concerning this article and any other skin issues, please leave a comment here on this blog, call our office directly or email through our website.

YOUR SKIN IS WHAT YOU EAT AND DRINK

 

I’m aware that the title of this blog post is unorthodox to say the least.  Although it may not put the prettiest picture in your head, it still got your attention, didn’t it?  Well, now I’ll explain what I mean by this title.

 

Nutrition plays a key role in the health and wellness of your skin.  What you regularly eat and drink not only fuels the body, but it also should provide the vital components to keep your skin looking young, strong and vital.  However, according to the US Department of Agriculture, most Americans don’t consume the adequate amounts of vitamins, minerals and antioxidants they need.

 

Truth be told, poor nutrition not only increases the risk of developing many systemic diseases such as diabetes and heart disease to name a few.  It also contributes to signs of premature skin aging.  Cell metabolism uses oxygen and nutrients to produce energy to run the cell itself.  Metabolism also produces waste products within the cell called “free radicals”, which are unstable atoms.  These “free radicals” can cause a dangerous chain reaction that can lead to the destruction of the cell itself.  Other types of stress on the body and skin such as smoking, UV light, and environmental toxins can also cause similar free radicals, leading to eventual cell damage.

 

Vitamins were discovered in the late 19th and early 20th century.  These and other chemicals were found to be antioxidants, meaning that they prevented the cell damage of free radicals.  In the most basic chemical terms, antioxidants bind up the free radicals and help to prevent the molecular alteration of cell damage.

 

Dr. Kenneth Cooper, of the Cooper Clinic in Texas, wrote a best-selling book, “The Antioxidant Revolution”.  In it, he discussed the role of these important antioxidants and good general nutrition in reversing the damage of aging and disease.  He believes and proved that proper supplementation, a balanced diet, plenty of fluids, and moderate exercise are all needed for good health and beautiful skin.  Additionally, topical antioxidants can protect the skin externally by binding the free radicals on the skin surface and preventing some of the damage caused by exposure to the sun.  As always, blocking the sun from damaging the skin in the first place is the first line of defense.

 

As the title of this article states, you and your skin are the result of what you take in and how you protect it.  As much as I like to help people reverse the damage to their skin by laser technology and injectable treatments, I believe that early prevention is the key to healthier skin in the long run.

 

If you have any questions concerning this article and any other skin issues, please leave a comment on our blog or call our office directly at (207) 873-2158 oremail through our website.

Acne:  What To Do Regardless of Age

Last week, my blog post concentrated on acne causes and other facts.  I also discussed the nasty problem of adult acne that seems to be increasing in frequency in recent years.  This week, I will discuss more treatments and new developments of this difficult problem.

In past decades, acne treatment was very singular in focus, meaning that only one type of remedy was used at a time.  Such a medication concentrated on treating only one aspect of the many causes of acne.  Recently, the latest philosophy is to attack acne on all fronts, and understandably so.  Current topical therapies that work best use combinations of ingredients to keep the acne in check.  These combined elements help to stop bacterial growth and reduce inflammation, sebum (oily matter in the hair follicles) production, & skin cell proliferation.

The best products for acne contain a combination of ingredients including retinols (that clear pores of excess cells and oil which can form pimples), benzoyl peroxide (that kills bacteria and increases oxygen into pores), salicylic acid (that kills bacteria and exfoliates) and glycolic acid (that eliminates old skin cells and fights inflammation).  The acne products I recommend contain these ingrediants in various combinations.  Maine Laser Skin Care’s own Acne Kits contain instructions on how and when to use the products and in what amounts.

For some acne patients, it may be necessary to use oral antibiotics to attack bacteria from the inside out.  Doxycycline and tetracycline are among the most common prescriptions that work for acne.  These antibiotics directly combat bacteria that feed off the oil and dead skin cells, and therefore treat and prevent pimples.

For many acne sufferers, topical products and antibiotics are not, by themselves, enough.  In 2002, the FDA approved the use of lasers to treat acne.  Since 2003, I have been using the 532 nanometer Aura Iridex laser to treat acne with excellent results.  This laser treats the root cause by destoring bacteria, shrinking oil glands and reducing pore size without damaging surrounding tissue.  Using the initial four treatment protocol over a period of two weeks can reduce active acne by as much as 70%.  Old and new acne scarring can be eliminated or significantly reduced by using a combination of several lasers that can target both superficial and deeper scars.  While the deepest scars will never completely go away, they can become much less prominent and can blend more easily into the person’s skin tone and complexion.

I am also looking to add to my regimen of acne treatments in the next year.  The most likely to be added soon is Photodynamic Therapy (or PDT) which involves the use of a topical prescription called Levulan.  Levulan highlights oil glands allowing the laser light to penetrate and destroy overactive glands also destroying bacteria.  PDT helps to treat severe cystic acne, acne rosacea, and even some types of skin cancer.  Another new treatment is the use of LED light for less severe acne cases (Blue Light is one brand name I have been looking at) with or without the use of Levulan or PDT.

When new treatments are available, I will let you know by this blog as well as adding the information to the website.  If you have any specific questions about these or any other skin care issues, call our office at (207) 873-2158 or email through our website.

Acne:  It’s Not Just For Teenagers Anymore

Although acne typically affects many teens, both male and female, adult acne is on the rise especially for women.  Some of the latest surveys show that 55% of new patients being treated for skin problems are adult females.  More on that statistic in just a moment.

 

First, though, I am sure many of you want to know the when, where, hows, and whys of this problem.When adult acne occurs, it lasts longer and usually does not resolve spontaneously without treatment.  The adult breakouts tend to center on the chin, jawline and neck.  Disturbingly, such breakouts occur when an adult is in his or her 20’s, and could potentially last well into his or her mid-40’s.  Many of these adult acne sufferers also did not necessarily have breakouts as teens.

Many factors can lead to adult acne.  While one factor alone may be to blame in some circumstances, it is usually a combination of factors for most adults .  Stress is a major factor, as it stimulates the hormonal systems which in turn activate the sebaceous glands, providing a growth medium for skin bacteria.  Studies have in fact shown increased levels of acne in women with high stress and fast paced jobs.  Women also tend to have more papules (large red areas that don’t come to a head) which are painful and look very angry and inflamed.

Women tend to outnumber men in adult acne as opposed to other way around in the teenage years.  In adult females, acne breakouts also occur during times of hormone fluctuations such as ovulation, menstrual periods, pregnancy and menopause.  I have seen many cases where changes in oral contraceptive types or stopping “the pill” can trigger acne also.

Many experts also blame environmental triggers such as foods treated with hormones, air pollution, and products that come in contact with our skin that can increase inflammation (depending on one’s allergies).  Many supposedly “safe” skin treatments found over-the-counter in drugstores and supermarket can promote skin inflammation in sensitive patients.  Such products can contain skin dehydration elements such as alcohol.  Also, many people find that their skin gets more sensitive as they gets older due to damage over the years.

After this rather depressing news, you may be saying to yourself, “Dr. Burke, what do I do now?”.  In the next blog post, I will outline in more detail specific ingredients and treatments that can reverse and eliminate this pesky problem especially facing adult women. In the meantime, if you go to the acne products section of our website, I have a number of safe but effective products that I recommend for adult and teen acne.  These products are very compatible with sensitive skin and laser-treated patients.

Next time, I will also discuss other new, cutting-edge treatments that I am considering adding to our menu of care for the age-old and still frustrating problem of acne.  Meanwhile, feel free to call or e-mail us with any pressing skin care questions you may have.

Keeping Up Appearances in a Down Economy

Despite the current economic climate, more women and men than ever are undergoing appearance-enhancing procedures such as Botox, Juvederm/Restylane injections, and laser treatments to maintain their aesthetic regimen.  Many other patients are forgoing expensive facelifts and other plastic surgeries to opt for less costly and less permanent changes to their appearance.

According to a recent article in the Wall Street Journal, 75% of the aesthetic physicians surveyed reported an increased demand for minimally invasive (or non-surgical) procedures such as Botox, fillers, and laser treatments in 2008 alone.   Surgeries such as breast augmentation and nose reshapings dropped dramatically at the same time.  Additionally, many patients described their use of such non-surgical treatments as “maintenance”, “like comfort food” and “part of my cost of doing business” (the article’s words, not mine).So why is this story significant?  Why exactly are more people trying minimally invasive procedures over other surgeries?

 

It may be because patients such as yourselves are aware of the potential dangers of invasive surgeries.  More than that though, people are also becoming more aware of cost differentials, especially with all the unavoidable economic news making daily headlines.  Whereas the average cost of Botox is $300-$400, and fillers $900-$1000, other surgeries such as facelifts can cost as much as $15,000, and that bill is almost never covered by health insurance either.  Besides these obvious differences in cost and convenience, patient satisfaction really speaks for itself.Here at Maine Laser Skin Care, I have seen amazing growth in such procedures in the past year.  Botox use increased 65%, and Juverderm went up 300% in the past year due in no small part to the reasons listed above.  I’m also proud to report that our office ranks as 3rd in the state of Maine and in the top 20 for all of New England–not bad for a business based in rural Maine.  I owe this good news to you all who have continued to support us, and have given us great feedback and suggestions that we have made it a point to follow up with.

As always, with the winter upon us, don’t forget to moisturize and sun block (yes, even in winter) to protect your largest organ–YOUR SKIN.  Drink lots of fluids, and call us with any questions or to discuss any of our treatments.

Note:  This entry was originally written as an e-newsletter exclusively for our subscribers on January 11, 2009.  The following information has been edited to illiminate dated references, but the main points of the article remain unchanged.  As always, feel free to contact us with any questions, or post any comments (within reason) you may have.

Sunscreen Basics

Despite the abundance of information out there about sunscreens, there is still much confusion among the public and even the popular press about the importance of using it regularly.  Therefore, at the risk of sounding like a broken record, here are some basic, but vital, facts about sunscreen that are frequently forgotten, ignored or not well known:

1. Sunscreens do exactly what the name says: They screen the sun, but cannot completely block it.  Therefore, their strengths are limited, and the importance of reapplication every so often is commonly overlooked.
2. One should always use sunscreens that contain both UVA and UVB protection.
3. For best results year-round, use sunscreen as part of your every morning routine no matter what time of year and type of weather.  Autumn is no exception, and winter especially poses a higher risk of sunburn than many realize.
4. When planning to be outdoors for lengthy periods, it is best to apply sunscreen at least 30 minutes before leaving the house.
5. Even so-called waterproof sunscreens will come off in water or with perspiration over time.  With this in mind, see Fact #6 below.
6. When swimming or perspiring with exercise outdoors, it is recommended that you reapply sunscreen every hour.
7. Always apply sunscreen over the backs of the hands, the neck, tops of the ears, and (for bald or balding men) the top of the head.  These are common areas of skin cancer growth and photoaging, and should avoid sun exposure as much as possible.
8. If you use a moisturizer or makeup with sunscreen in it, make sure the SPF rating is at least 30, especially for facial use.
9. Regardless of the amount of sunscreen used, try to avoid sun exposure during the peak UV exposure times of 10 A.M. to 2 P.M.
10. The best sunscreen in the world (see our product line) won’t work if you don’t use it regularly, or properly for that matter.  Make it a daily habit, like brushing your teeth or combing your hair.

Also, I have said many times in this blog that it is far easier to prevent sun damage in the first place, than to repair its effects afterwards.  We have the technology to repair much of the damage, but simple prevention is far less expensive.  So go out there, have fun, and take special care of your largest organ–your skin. Thanks again for reading this, and for your consistent support!  We will keep providing you with our great customer service.

Botox Update II

I was presented with some very good news recently which you may be interested in.

I met with a representative from Allergan- the pharmaceutical company that makes Botox and Juvaderm.  She brought along some amazing information concerning the use of those products in my practice.  I’m proud to say that I currently rank in the Top 20 of all the aesthetic doctors in New England who use Botox and Juvaderm.  I also rank 3rd in the state of Maine. This is all the more amazing as many of the other skin doctors are in much more populated areas such as Portland, Maine, Burlington, Vermont and Portsmouth/Manchester/Concord, New Hampshire.

The number of people who use Botox has still been growing, but due to the hit the economy took, that growth has actually slowed down to 10% per year in the U.S. and to 4% per year in New England.  However, Maine Laser’s growth alone has stayed at over 50% per year every year since we started using Botox four years ago.

Our patient satisfaction scores and repeat patient treatments are both very high compared to other doctors in this field.  I am very proud of this growth and the response of patients to the availability of cutting-edge aesthetic care in central Maine.  Next month, in cooperation with Allergan, we will be rolling out several promotions to help keep Botox and Juvederm affordable.  We will keep you posted as plans develop.

Last but not least, I discussed Botox in more detail in an earlier post.  Because of these exciting developments I just detailed, I just posted that newsletter on our blog, so feel free to check that out if you have any further questions.

Thanks again for reading this, and for your consistent support!  We will keep providing you with our great customer service.

-This entry was originally written as an e-newsletter exclusively for our subscribers on September 21, 2008.  The information had been edited to illiminate dated references, but the main points of the article remain unchanged.  As always, feel free to contact us with any questions, or post any comments (within reason) you may have.